Mental Health Today — are we serving our community?

Like many communities bifurcated by both their religious understanding (Sikhi) and their ethnic/racial identities (for many of us, Punjabi), there are unique challenges to providing comprehensive mental health services to immigrant communities. Within the context of California, this is not only compounded by a lack of language access, but also by the vast isolation and transportation difficulties for those in the more rural areas of the state. And on top of all of that, the sheer diversity of issues that face Sikhs in the U.S. — from torture and domestic violence to struggling with learning disabilities, substance abuse, or depression — can exacerbate the experience for those who may already feel stigmatized.

A small but growing body of work examining how the religious and ethnic context of Sikh and Punjabi identity reframe service provision. Within the ABD, Punjabi, Sikh community in the Bay Area, a growing number of public health students are focusing their research specifically on mental health services, underreporting, and (the lack of access to) treatment.

Recently at The Langar Hall, we’ve discussed a variety of topics that seem to come back to the issue of mental health, both in the U.S.-diaspora and in Indian Punjab. There are certainly unique historical factors that contribute to what feels like a high incidence of mental health needs in the Punjabi community, but perhaps there are other factors at well. And while a significant number of ABD Punjabis become health professionals, how many have the language access needed to deliver health services and comfort newer immigrants? Are there new initiatives taking place, or are new resources being provided via already existing organizations? Some organizations (particularly DV organizations) have begun visiting at places of worship to do intake, but the need for translators is always a limiting factor. There’s a lot of energy bubbling around this, but will we see it concretely manifested soon? Do you see the need for outreach and services in your own local community? Or do you know of services and resources that are religiously-sensitive and culturally relevant?


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8 Responses to “Mental Health Today — are we serving our community?”

  1. Nicole says:

    Camille –

    The need for mental health services in our community is a large problem and sadly I have not seen any religiously-sensitive and cuturally relevent resources. A lot of mental health professional training is only now begining to teach cultural sensitivity to it's students. Most schools, especially research institutions, do not even take into consideration cultural sensitivity in the design of their training. Thus, I believe this is where the root of the problem is derived. I do hope that with the grow of mental health education and professioal programs in learning about diverse communities, culturally sensitive mental health professionals increase as well. Unfortunately, there will be a lag time before this occurs.

    In regards to the Punjabi Sikh community, I agree that language barriers are a huge problem. The thing is, how do we even help? Does anyone know how you can be a translator for mental health administration? See, sometimes its like you dont know where to begin to be able to help even if there is something you can do.

  2. Nicole says:

    Camille –
    The need for mental health services in our community is a large problem and sadly I have not seen any religiously-sensitive and cuturally relevent resources. A lot of mental health professional training is only now begining to teach cultural sensitivity to it’s students. Most schools, especially research institutions, do not even take into consideration cultural sensitivity in the design of their training. Thus, I believe this is where the root of the problem is derived. I do hope that with the grow of mental health education and professioal programs in learning about diverse communities, culturally sensitive mental health professionals increase as well. Unfortunately, there will be a lag time before this occurs.
    In regards to the Punjabi Sikh community, I agree that language barriers are a huge problem. The thing is, how do we even help? Does anyone know how you can be a translator for mental health administration? See, sometimes its like you dont know where to begin to be able to help even if there is something you can do.

  3. Sundari says:

    Camille, thanks for posting on this. I definitely don't think we are doing enough to address the issue of mental health among Punjabis. There have been some programs developed in Canada and the UK to deal with mental health issues impacting Punjabis, but I haven't been aware of similar programs in the US. Several of these programs offer information in Punjabi too. For example, the Center for Addiction and Mental Health in Canada provides information about Mental Health, Asking For Help When Things Are Not Right, Understanding Addiction, and Coping With Stress. Now, although I can't say how complete these services are, I think they probably came about because finally there was the realization that a whole community of individuals weren't getting care in a culturally sensitive manner.

    This issue reminds me of something. Some of you may recall the tragic story of Navjeet Sidhu from Southall who committed suicide in 2005 by jumping infront of a train, taking her two children with her. Six months later her mother also committed suicide at the very same spot. That story really struck me and has stayed with me, especially since it was noted that one third of suicides were linked to a railway line going through Southall! Data shows us that depressive diagnoses are more common among Punjabi women than their English counterparts. For example, Asian women living in the UK are three times more likely to commit suicide. These numbers are staggering! While I realize the differences in the Punjabi communities in England versus the US, we have to be able to identify and associate a similar prevalence in our community here. I don't know what the answer is, but it's definitely got me thinking. This isn't an issue we're addressing adequately and I do wonder what we can do to help…

  4. Sundari says:

    Camille, thanks for posting on this. I definitely don’t think we are doing enough to address the issue of mental health among Punjabis. There have been some programs developed in Canada and the UK to deal with mental health issues impacting Punjabis, but I haven’t been aware of similar programs in the US. Several of these programs offer information in Punjabi too. For example, the Center for Addiction and Mental Health in Canada provides information about Mental Health, Asking For Help When Things Are Not Right, Understanding Addiction, and Coping With Stress. Now, although I can’t say how complete these services are, I think they probably came about because finally there was the realization that a whole community of individuals weren’t getting care in a culturally sensitive manner.

    This issue reminds me of something. Some of you may recall the tragic story of Navjeet Sidhu from Southall who committed suicide in 2005 by jumping infront of a train, taking her two children with her. Six months later her mother also committed suicide at the very same spot. That story really struck me and has stayed with me, especially since it was noted that one third of suicides were linked to a railway line going through Southall! Data shows us that depressive diagnoses are more common among Punjabi women than their English counterparts. For example, Asian women living in the UK are three times more likely to commit suicide. These numbers are staggering! While I realize the differences in the Punjabi communities in England versus the US, we have to be able to identify and associate a similar prevalence in our community here. I don’t know what the answer is, but it’s definitely got me thinking. This isn’t an issue we’re addressing adequately and I do wonder what we can do to help…

  5. Nicole says:

    Maybe one way we can help is by gathering this data on ourselves, putting together our own research on depression, suicide, mental health problems and disorders and the prevalence of these occurrences within our community. After we have this information, we could go around to our local Gurdwaras and present our research and findings to the Sikh community. This way people who may be going through something similar understand how common it is and won’t feel so ashamed to get help if they are in the same situations. Of course, we would also have to research mental health resources for them.

    These resources may not be "culturally sensitive" in the way that we would like but honestly it's better to have some help than no help. At least within California, Women's Shelters are broken out into districts, so there is always one in a given area. Also, your county Health Department should have some resources as well. We could give them information about these places but I'm not sure how they would get translators.

    I do think the problem is that people don't even know where to go. Maybe this could help, I'm not sure.

  6. Nicole says:

    Maybe one way we can help is by gathering this data on ourselves, putting together our own research on depression, suicide, mental health problems and disorders and the prevalence of these occurrences within our community. After we have this information, we could go around to our local Gurdwaras and present our research and findings to the Sikh community. This way people who may be going through something similar understand how common it is and wont feel so ashamed to get help if they are in the same situations. Of course, we would also have to research mental health resources for them.

    These resources may not be “culturally sensitive” in the way that we would like but honestly it’s better to have some help than no help. At least within California, Women’s Shelters are broken out into districts, so there is always one in a given area. Also, your county Health Department should have some resources as well. We could give them information about these places but I’m not sure how they would get translators.

    I do think the problem is that people don’t even know where to go. Maybe this could help, I’m not sure.

  7. Camille says:

    I'm sorry for the long delayed responses, ladies! Nicole, I know there are a few public health students at SFState and UCSF/UCB who have been doing community surveys and health ethnographies, particularly of the Sikh/Punjabi community (unfortunately, their research is not yet published or linked online), but I do think your point re: data collection is on-point.

    In terms of community initiatives, my anecdotal experience is that with the continuing demystification of depression and the lessening stigma around counseling and mental health among 2nd/3rd gen ABDs, there is a growing interest in creating relevant counseling services for communities such as our own. I think there are fantastic health groups out there who would benefit from pairing up with interested young Sikhs, who in turn could lend strength to those organizations (esp. umbrella affinity organizations). And, realistically, gurdwaras and dhabas are very much at the heart of community exchange for Punjabi Sikhs — it is normal and natural to consider doing health outreach in these locations. I think questions I would have are: 1. What would a Punjabi/Sikh sensitive counseling model look like? 2. How would you outreach?

    Finally, with respect to translation, many county health offices (e.g., Alameda County) allow volunteers to translate for DSS, etc. This might be a great way to pair up with pre-existing programs to create a larger network of volunteer translators, esp. if local non-profits are pulled into the mix.

  8. Camille says:

    I’m sorry for the long delayed responses, ladies! Nicole, I know there are a few public health students at SFState and UCSF/UCB who have been doing community surveys and health ethnographies, particularly of the Sikh/Punjabi community (unfortunately, their research is not yet published or linked online), but I do think your point re: data collection is on-point.

    In terms of community initiatives, my anecdotal experience is that with the continuing demystification of depression and the lessening stigma around counseling and mental health among 2nd/3rd gen ABDs, there is a growing interest in creating relevant counseling services for communities such as our own. I think there are fantastic health groups out there who would benefit from pairing up with interested young Sikhs, who in turn could lend strength to those organizations (esp. umbrella affinity organizations). And, realistically, gurdwaras and dhabas are very much at the heart of community exchange for Punjabi Sikhs — it is normal and natural to consider doing health outreach in these locations. I think questions I would have are: 1. What would a Punjabi/Sikh sensitive counseling model look like? 2. How would you outreach?

    Finally, with respect to translation, many county health offices (e.g., Alameda County) allow volunteers to translate for DSS, etc. This might be a great way to pair up with pre-existing programs to create a larger network of volunteer translators, esp. if local non-profits are pulled into the mix.